Complex medical history and thumb sucking – Republished

Q:

I am a parent of a 3 year old. My child had a rough start, she was born early and was hospitalized for about 5 months with major complications including malignant sleep apnea, difficulty feeding, PDA ligation, IVH III (no shunt at this time), and a cerebellar stroke. She is a miracle and we thank God every day, but she continues to have a few problems even though when evaluated at 2 1/2 and 3 years she tested between a 3 to 4 year old. She, does not talk although she occasionally says mama and has said da, ba, no, and yes before. She has picked up sign language quite well, but her lack of expressive language is a concern. We are also, concerned because we have not been able to break her thumb sucking habit, we have been wrapping her thumb with elastic sports bandage which keeps her from sucking as long as she has it on, but as soon as it comes off the thumb goes back in the mouth. Also, when her thumb is wrapped she sucks on her tongue with her hand near her mouth. Another concern is a tongue thrust which she has always had, she has been seeing speech therapists since birth and the tongue thrust continues. She recently turned three and was discharged from ECI Services and has started a L.E.A.P. (Language and Early Articulation Program ). Please advise a concerned parent. Thank you and God bless you and your wonderful gift.

A:

Hi L Forgive me for not getting  back with you sooner.  I really wanted time to sit and think before answering your email.  I am giving my opinion based on the history you gave me and the current state of her thumb, speech, and language.  As you know, among my specialty areas are “tongue thrust” and sucking habits, along with the typical language and speech areas that are seen by speech pathologists.  Here are my thoughts and I do feel strongly about them: Do nothing at this time to discourage her from sucking her thumb.  She is quite young to provide a sucking elimination program, even if she had not been through so much already in her couple of years on earth.  Secondly, for some children who are not developing speech at the normal rate, sucking and mouthing may be needed.  If you can provide substitutes like sucking on popsicles or even sanitary rubber tubing that some pediatric speech therapists use…that is fine; if not, then it is best not to bring anything negative into the relationship you have with your daughter.  Don’t bug her at all about her sucking habit for now. Regarding the thrusting. No therapist should be working with that at this time.  It is likely related to the sucking habit since the thumb puts the tongue into an unnatural location and even when the thumb is removed, the tongue is still going to remain in that misplaced location for speech and other functions.  Again, she is far too young for that type of program. Regarding her language and expressive speech difficulties.  Is her ability to understand language and commands and requests at a level that is acceptable for her age?  I get the feeling that it is her expressive abilities in speech and language that are “behind”…is that correct?  If so, then most good speech pathologists should be able to make a marked difference for her even after 9 months or so.  She will probably need a lot of continued therapy for several years to completely catch up, providing there are no concomitant learning problems that occurred from all her past surgeries, etc. How is she socially?  Is she interactive with other children and adults?  I think the class she’s in now should be very helpful.  Every three months or so, you should be noticing big changes in her language and speech; if not, I would be sure to speak with her teacher frequently and her school therapist, asking them to send you helpful assignments to work on at home with her. I hope this is a least a little bit helpful; if nothing else, I hope you follow my suggestions to forget about taping the thumb or any other negative approaches….